Pulse

Getting a handle on seizures

In a new epilepsy program at Bayfront Medical Center, a young adult suffering from seizures spends four days wired with electrodes as doctors try to pinpoint why her brain short-circuits.

By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times
published January 21, 2003

Christa Haislop's brain has misfired since she was 5 years old. Sometimes there is a week or two of calm before the storm. Other times the electrical zaps hit in rapid succession on a single day.

One seizure floats her arms from her sides.

Another makes her fall to the floor and convulse.

Afterward she is fatigued and confused. More frightening is the prison of waiting for a seizure to strike. Haislop has severe epilepsy, not completely controlled by medication, which shackles the 18-year-old to home or to parental accompaniment when she goes out.

Dr. Erasmo Passaro hopes to decipher what is happening in Haislop's brain.

Can her seizures be stopped?

"It's like a puzzle. Someone like Christa, who's discouraged, who says they've tried everything, it's challenging," Passaro says. "The goal is to be seizure free."

Trained at the UCLA Reed Neurological Research Center, one of the first comprehensive epilepsy centers in the United States, and most recently director of the adult epilepsy laboratory at the University of Michigan Medical Center, Passaro last summer accepted a position at Bayfront Medical Center to develop a comprehensive epilepsy program. The St. Petersburg hospital is one of five regional referral centers for epilepsy and seizure disorders in Florida.

Last week Haislop checked into Bayfront to be monitored around the clock for four days. Passaro wanted to determine what types of seizures she suffers and where in her brain they originate.

A seizure is a sudden, temporary change in a person's movements, sensations or consciousness caused by an electrical discharge in the brain. By defining the type and origin of seizures, neurologists, surgeons and others can tailor medications or pinpoint where surgical removal of a portion of the brain may stop them.

Haislop's parents say they long for answers.

"She's been on 13 different types of medicine, and she's never been controlled," says her mother, Patty Haislop, who began schooling her daughter at home in Odessa rather than send her to middle school.

"She's never been able to ride a bicycle. She can't go to the mall with her girlfriends."

"It makes me afraid," Christa says.

At the hospital, she hugged a stuffed cat named Dootz for comfort and watched Joe Millionaire on television to pass the time. Her mother was staying with her in her room.

When she arrived, a nurse glued 30 electrodes to her scalp to measure the electrical activity in her brain. Haislop has had electroencephalograms before, and MRIs to scan for abnormalities in her brain's physical structure. This time both screenings were more sophisticated: digital EEG, which permits computer manipulation, and a high-resolution epilepsy MRI.

The electrode wires fed into a box Haislop either carried like a purse or wore as a belt, which amplified the signals. A cable carried the signals to computers in the lab next door. Each electrode sent out its own squiggly, labeled line -- odd numbers for left brain electrodes, even for right -- not unlike seismographs awaiting an earthquake's rattle.

A video camera in Haislop's room took a visual picture that could be synchronized with the EEG to detail a seizure.

Passaro says that about half the people with epilepsy become seizure-free on the first medication prescribed and an additional 10 to 12 percent get relief with the addition of a second. The remaining one-third or so do not respond.

Because the EEG and video are much more accurate than patient descriptions and medical observation of seizures, Passaro says that about 60 to 70 percent of patients evaluated in this way change their treatment afterward.

Haislop, whose seizures have never been fully controlled, takes 20 pills of two medications every day. Almost 20 drugs are used to prevent or modify seizures, half of them introduced in the last 10 years.

By day three with Haislop, Passaro and his staff had identified two kinds of seizures in the "spike" and "slow wave" of the EEG lines and the physical changes caught on video. The irritability appears to begin in the right frontal lobe in the EEG. On the video, Haislop stares, then looks to the left and turns her head to the left. Her eyes begin rapidly blinking as her teeth clench. As the seizure ends, her eyes move back to the right, followed by her head.

The movements are key pieces to the puzzle, Passaro says.

"It tells me (the seizure) starts in the area of the brain that controls eye movement," he says.

Haislop had four of these seizures in one day. The other kind of seizure Passaro observed is called a tonic seizure, in which Haislop's arms involuntarily lift from her sides.

A seizure may be as subtle as smacking lips or a bad taste in the mouth. Or it may be called a grand mal, or generalized tonic clonic, seizure, which lasts a few minutes. Muscles go limp, teeth clench and bite the tongue, and limbs jerk.

Meanwhile, Haislop's MRI has revealed, for the first time, a subtle malformation in her right frontal cortex, where Passaro believes some of her seizures originate.

More work needs to be done, but this is a good beginning, he says. "We named the events (seizures) she is having, we're going to try different medicine, and we may repeat the MRI to further look at that area of the brain."

About 1.6-million people in the United States have epilepsy, which is most often diagnosed before age 20 and after age 60.

"It's a hard thing to live with," Haislop says. "I want them to see where my seizures are coming from, so they can take out that part of my brain.

"I would like to go on a trip to another state, and see mountains."

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